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Prospective Series (prospective + series)
Selected AbstractsBiopsy site selection for endobronchial ultrasound guide-sheath transbronchial biopsy of peripheral lung lesionsINTERNAL MEDICINE JOURNAL, Issue 2 2008D. I. K. Fielding Abstract Background: Choice of biopsy method for peripheral lung lesions is usually between CT-guided fine-needle aspiration biopsy (CT FNA) and bronchoscopy. Endobronchial ultrasound guide-sheath biopsy (EBUS GS) is a new method to improve the yield of bronchoscopy. Guidance on which lesions would be appropriate for either method is needed. The aim of the study was to compare the diagnostic yields and pneumothorax rate of EBUS GS and CT FNA in terms of the location of the lesion needing biopsy, in particular, whether the lesion is touching the pleura. Methods: Prospective series of EBUS GS were compared to retrospective review of CT FNA carried out simultaneously in a large teaching hospital. Results: For EBUS GS 140 cases were carried out with mean lesion size 29 mm. Overall diagnostic sensitivity was 66%. For lesions not touching visceral pleura it was 74% compared with 35% where it was on the pleura (P < 0.01). For CT FNA 121 cases were carried out with mean lesion size 37 mm. The overall diagnostic sensitivity was 64%. Rate of pneumothorax and ICC placement in EBUS GS was 1 and 0% and in CTFNA was 28 and 6%, with P < 0.001 for both. Conclusion: Lesion location, in particular, connection to the visceral pleura, can improve decision-making in referral for either CT FNA or EBUS GS to maximize diagnostic yield and minimize pneumothorax rate. [source] Long-term great auricular nerve morbidity after sacrifice during parotidectomy,THE LARYNGOSCOPE, Issue 6 2009William R. Ryan MD Abstract Objectives/Hypothesis: To clarify the extent and patient perspectives of great auricular nerve (GAN) morbidity and recovery after nerve sacrifice during parotidectomy 4 to 5 years after surgery. Study Design: Prospective series. Methods: Twenty-two patients who underwent parotidectomy with GAN sacrifice and were previously studied for GAN sensory outcome during the first postoperative year. We performed light touch sensation tests on each patient to develop an ink map representing anesthesia and paresthesia in the GAN sensory territory; patients also completed an outcomes questionnaire. Results: Nineteen (86%) of 22 patients completed follow-up. One patient completed the questionnaire over the phone. The prevalence and average areas of anesthesia and paresthesia decreased since the first postoperative year according to sensory testing and patient scoring. At 4 to 5 years, 47% (9 of 19) of the patients had anesthesia, 58% (11 of 19) had paresthesia, and 26% (5 of 19) had neither anesthesia nor paresthesia during sensory testing. Patients reported that the GAN dysfunction brought them no to mild inference with their daily activities. At a mean point of 2 years, 70% (14 of 20) patients felt that their sensory symptoms had either completely abated or stabilized. Conclusions: The posterior branch of the GAN should be preserved if it does not compromise tumor resection. If this is not possible, the patient and surgeon should be comforted in that only minor, if any, long-term disability will ensue. Laryngoscope, 2009 [source] Low-risk HLA genotype in Type 1 diabetes is associated with less destruction of pancreatic B-cells 12 months after diagnosisDIABETIC MEDICINE, Issue 12 2007M. Spoletini Abstract Aims The role of human leukocyte antigen (HLA) genes in the susceptibility to Type 1 diabetes (T1DM) is well known. However, we do not know whether the degree of pancreatic B-cell destruction depends on different HLA genetic risk. The aim of this study was to analyse the influence of DRB1* and DQB1* genes on the rate of pancreatic B-cell loss in a prospective series of 120 consecutive newly diagnosed T1DM subjects in the first 12 months after diagnosis. Methods Patients were typed for HLA-DRB1* and DQB1* loci by a reverse line blot assay using an array of immobilized sequence-specific oligonucleotide probes. C-peptide, insulin requirement and glycated haemoglobin (HbA1c) were determined at diagnosis and every 3 months for 12 months. The variance of C-peptide as evidence of B-cell loss during follow-up was analysed using the general linear model for repeated-measures procedure. Results Fasting C-peptide in T1DM subjects with low HLA genetic risk was significantly higher when compared with subjects with moderate or high HLA genetic risk from time of diagnosis up to 12 months (P = 0.007 and P = 0.0002, respectively). Nonetheless, the changes in C-peptide levels over a 12-month period did not differ significantly between T1DM subjects with different HLA genetic risks. Conclusions Low-risk HLA genotype in T1DM is associated with less destruction of pancreatic B-cells up to 12 months after diagnosis. These results are useful when designing trials for therapies aimed to prevent the progression of B-cell destruction in recent-onset T1DM. [source] Dense array EEG: Methodology and new hypothesis on epilepsy syndromesEPILEPSIA, Issue 2008Mark D. Holmes Summary Dense array EEG is a method of recording electroencephalography (EEG) with many more electrodes (up to 256) than is utilized with standard techniques that typically employ 19,21 scalp electrodes. The rationale for this approach is to enhance the spatial resolution of scalp EEG. In our research, dense array EEG is used in conjunction with a realistic model of head tissue conductivity and methods of electrographic source analysis to determine cerebral cortical localization of epileptiform discharges. In studies of patients with absence seizures, only localized cortical regions are involved during the attack. Typically, absences are accompanied by "wave,spike" complexes that show, both at the beginning and throughout the ictus, repetitive cycles of stereotyped, localized involvement of mainly mesial and orbital frontal cortex. Dense array EEG can also be used for long-term EEG video monitoring (LTM). We have used dense array EEG LTM to capture seizures in over 40 patients with medically refractory localization-related epilepsy, including both temporal and extra temporal cases, where standard LTM failed to reveal reliable ictal localization. One research goal is to test the validity of dense array LTM findings by comparison with invasive LTM and surgical outcome. Collection of a prospective series of surgical candidates who undergo both procedures is currently underway. Analysis of subjects with either generalized or localization-related seizures suggest that all seizures, including those traditionally classified as "generalized," propagate through discrete cortical networks. Furthermore, based on initial review of propagation patterns, we hypothesize that all epileptic seizures may be fundamentally corticothalamic or corticolimbic in nature. Dense array EEG may prove useful in noninvasive ictal localization, when standard methods fail. Future research will determine if the method will reduce the need for invasive EEG recordings, or assist in the appropriate placement of novel treatment devices. [source] Results of laparoscopic splenectomy for treatment of malignant conditionsHPB, Issue 4 2001E M Targarona Background Laparoscopic splenectomy (LS) is widely accepted for treatment of benign diseases, but there are few reports of its use in cases of haematological malignancy. In addition, comparative studies with open operation are lacking. Malignant haematological diseases have specific clinical features - notably splenomegaly and impaired general health - which can impact on the immediate outcome after LS. The immediate outcome of LS comparing benign with malignant diagnoses has been analysed in a prospective series of 137 operations. Patients and methods Between February 1993 and April 2000, 137 patients with a wide range of splenic disorders received LS. Clinical data and immediate outcome were prospectively recorded, and age, diagnosis, operation time, perioperative transfusion requirement, spleen weight, conversion rate, accessory incision, hospital stay and complications were analysed. Results The series included 100 benign cases and 37 suspected malignancies. In patients with malignant diseases the mean age was greater (37 years [3,85] vs 60 years [27,82], p <0.01), LS took longer (138 min [60,400] vs 161 min [75,300], p <0.05) and an accessory incision for spleen retrieval was required more frequently (18% vs 93%, p <0.01) because the spleen was larger (279 g [60,1640] vs 1210 g [248,3100], p <0.01). However, the rate of conversion to open operation (5% vs 14%), postoperative morbidity rate (13% vs 22%) and transfusion requirement (15% vs 26%) did not differ between benign and malignant cases. Hospital stay was longer in malignant cases (3.7 days [2,14] vs 5 days [2,14], p <0.05). Conclusion LS is a safe procedure in patients with malignant disease requiring splenectomy in spite of the longer operative time and the higher conversion rate. [source] Childhood Onset Vulvar Lichen Sclerosus Does Not Resolve at Puberty: A Prospective Case SeriesPEDIATRIC DERMATOLOGY, Issue 6 2009Saxon D. Smith M.B.Ch.B. However when it occurs in adult women it is accepted that remission is unlikely and that in addition untreated or inadequately treated disease may be complicated by significant disturbance of vulvar architecture and less commonly squamous cell carcinoma. Our database reveals 18 girls who developed lichen sclerosus prior to puberty who are now adolescents or young adults. Twelve have remained under surveillance and the other six patients have been lost to follow-up. We report a prospective series of these 12 patients. Three patients have achieved complete remission sustained for three or more years, all prior to menarche. Nine patients, or 75% of the cohort, who still had active lichen sclerosus at puberty continue to require maintenance therapy after menarche. Of the 12, six have had significant disturbance of vulvar architecture. The concept that prepubertal lichen sclerosus resolves at puberty would appear not to be true in the majority of patients. Even when diagnosed early and treated effectively, childhood onset lichen sclerosus may be complicated by distortion of vulvar architecture. [source] Lymphatic Mapping and Sentinel Lymphadenectomy for 106 Head and Neck Lesions: Contrasts Between Oral Cavity and Cutaneous Malignancy,THE LARYNGOSCOPE, Issue S109 2006FACS, Francisco J. Civantos MD Abstract Objectives: The objectives of this prospective series were to present our results in 106 sequential cases of lymphatic mapping and sentinel lymph node biopsy (SLNB) in the head and neck region and contrast the experience in oral cancer with that for cutaneous lesions. Hypotheses: SLNB has an acceptably low complication rate in the head and neck. Lymphatic mapping and gamma probe-guided lymphadenectomy can improve the management of malignancies of the head and neck by more accurate identification of the nodal basins at risk and more accurate staging of the lymphatics. For appropriately selected patients, radionuclide lymphatic mapping may safely allow for minimally invasive sentinel lymphadenectomy without formal completion selective lymphadenectomy. Methods: One hundred six patients underwent intralesional radionuclide injection and radiologic lymphoscintigraphy (LS) on Institutional Review Board-approved protocols and 103 of these underwent successful SLNB. These included 35 patients with malignant melanoma, 10 cutaneous squamous cell carcinomas, four lip cancers, eight Merkel cell carcinomas, two rare cutaneous lesions, and 43 oral cancers. Mean follow up was 24 months. Patients with oral cavity malignancy underwent concurrent selective neck dissection after narrow-exposure sentinel lymph node excision. In this group, the SLNB histopathology could be correlated with the completion neck specimen histopathology. Patients with cutaneous malignancy underwent SLNB alone and only received regional lymphadenectomy based on positive histology or clinical indications. Data were tabulated for anatomic drainage patterns, complications, histopathology, and patterns of cancer recurrence. Results: Surgical complications were rare. No temporary or permanent dysfunction of facial or spinal accessory nerves occurred with sentinel node biopsy. Lymphatic drainage to areas dramatically outside of the expected lymphatic basins occurred in 13.6%. Predictive value of a negative sentinel node was 98.2% for cutaneous malignancies (based on regional recurrence) and 92% with oral cancer (based on pathologic correlation). Gross tumor replacement of lymph nodes and redirection of lymphatic flow represented a significant technical issue in oral squamous cell carcinoma. Sixteen percent of patients with oral cancer were upstaged from N0 to N1 after extended sectioning and immunohistochemistry of the sentinel node. Conclusions: LS and SLNB can be performed with technical success in the head and neck region. Complications are minimal. More accurate staging and mapping of lymphatic drainage may improve the quality of standard lymphadenectomy. The potential for minimally invasive surgery based on this technology exists, but there is a small risk of missing positive disease. Whether the failure rate is greater than that of standard lymphadenectomy without gamma probe guidance is not known. New studies need to focus on refinements of technique and validation of accuracy as well as biologic correlates for the prediction of metastases. [source] Apolipoprotein E,dependent accumulation of Alzheimer disease,related lesions begins in middle age,ANNALS OF NEUROLOGY, Issue 6 2009Eloise Kok BScHons Objective To study the prevalence and age dependency of senile plaques (SP) and neurofibrillary tangles (NFT), the brain changes characteristic of Alzheimer disease (AD), and their association with apolipoprotein E (APOE) genotypes in a community-dwelling normal population. Methods This neuropathological study used both silver staining and A, immunohistochemistry in brain tissue microarrays, including SP coverage and NFT counts from frontal cortex and hippocampus, and APOE genotyping, and was performed on a consecutive prospective series of 603 subjects (aged between 0 and 97 years) of an unselected population living outside of institutions. Cases were subjected to autopsy following sudden or unexpected out-of-hospital death, covering 22.1% of the mortality of Tampere, Finland and its surroundings. None died of AD, although 22 (3.7%) were demented and 10 (1.7%) had memory problems. Results Of the series, 30.8% had SP, and 42.1% had NFT; these occurred more commonly among females and showed a strong relationship with age. Both changes had already appeared at around 30 years of age, reaching an occurrence of almost 100% in the oldest. SP were more frequent in APOE ,4-carriers compared with noncarriers in every age group except the oldest (>90 years). The difference was most evident during the ages 50 to 59 years, where 40.7% of ,4-carriers had SP, compared with 8.2% in noncarriers (odds ratio, 8.39; 95% confidence interval, 2.55,27.62). The difference in NFT prevalence between APOE genotypes was not statistically significant in any age group. Interpretation The brain changes associated with AD may already begin developing early in middle age, especially among APOE ,4 carriers. Ann Neurol 2009;65:650,657 [source] PREPERITONEAL GROIN HERNIA REPAIR WITH KUGEL PATCH THROUGH AN ANTERIOR APPROACHANZ JOURNAL OF SURGERY, Issue 10 2008Junsheng Li Kugel hernia repair is classically carried out through the posterior approach; in this study we investigated the effectiveness and invasiveness of a Modified Kugel (Bard-Davol Inc., RI, USA) hernia repair procedure carried out through an anterior approach. A prospective series covering a 2-year period, including 122 patients (142 hernias) were carried out using the anterior approach. Patient comfort, complications and recurrence were evaluated. A total of 142 inguinal hernias were repaired, median age was 67 years, the mean operation time was 51 ± 23 min and the average incision was 4.5 cm. There was one case recurrence 5 months after repair. Other complications were few and not severe, only slight groin discomfort was observed in two patients during follow up. This Modified Kugel hernia through anterior approach is effective, mini-invasive and easy to learn with fewer complications. [source] HN10P METASTATIC CUTANEOUS SQUAMOUS CELL CARCINOMA TO THE PAROTID GLANDANZ JOURNAL OF SURGERY, Issue 2007G. D. Watts Purpose With an incidence rate of 300 cases per 100000 population per year, Australia has the highest incidence of cutaneous squamous cell carcinoma (SCC) in the world. Metastatic cutaneous SCC in parotid lymph nodes are aggressive tumours with poor outcomes both in terms of local control and survival. Methodology This study reports a prospective series of 41 consecutive patients with metastatic SCC to the parotid gland in a major teaching hospital in Western Australia over a six-year period from January 2000 to December 2005. Epidemiological, clinical, histopathological and treatment details along with patterns of failure were extracted from the database. The survival and failure curves were calculated using the Kaplan-Meier method. Univariate and multivariate analysis were performed using Cox regression method. Results The five-year absolute survival is 34.2% and the cancer specific survival 39.5%. Local failure was observed in 11 patients for an actuarial rate of local disease free survival of 65.8% at 6 years. Distant failure occurred in two patients for an actuarial distant disease free survival of 89.5% at 6 years. Both univariate and multivariate analysis failed to find any predictors of local or distant failure with statistical significance. Conclusions Multimodality treatment will still fail to locally control or cure at least a third of patients. Previously identified risk factors were not substantiated in this study and may relate to patient numbers. Parotidectomy and post-operative radiotherapy remain the gold standard. Unlike their cutaneous counter parts metastatic SCC to the parotid gland remains an aggressive tumour with current treatment regimes. [source] Surgical management of colorectal cancer in south-western Sydney 1997,2001: a prospective series of 1293 unselected cases from six public hospitalsANZ JOURNAL OF SURGERY, Issue 9 2005S. K. Cyril Wong Background: The aim of the present study is to provide local data for the management of colorectal cancers in the south-western Sydney health area from 1997 to 2001. Methods: The data were collected prospectively. Follow up was conducted in late 2001 and early 2002. Data were cross-validated with hospital and area databases and with data from the New South Wales Registry of Births, Deaths and Marriages. Results: This was an unselected series of 1293 patients from 36 surgeons; 16.5% of patients presented as emergencies. Only 3% presented as a result of bowel cancer screening. Of the 1293 patients, 1270 received an operation. There were 598 elective colonic resections with the mortality rate of 1.2%, reoperation rate of 2.7% and anastomotic leak rate of 0.8%. For the 410 elective rectal resections, the rates were 2.9%, 2.7% and 1.2%, respectively. For the 290 emergency operations, the rates were much worse at 7.7%, 6.6% and 4.8%, respectively. The corrected overall 3-year survival rate was 64%. For Dukes' A, B, C and D, the figures were 94%, 87%, 61% and 7%, respectively. Conclusions: Colorectal cancer is a major cause of mortality and morbidity in our community. Very few bowel cancers were discovered at the asymptomatic stage. This paper strongly supports community bowel cancer screening and early diagnosis. The local database has provided a rich source of information to benchmark management and outcomes of bowel cancer patients treated in the South Western Sydney Area Health Service. An area-wide computer network with online data input facilities at individual workplaces will improve data integrity and data collection efficiency. [source] Predicting postoperative morbidity by clinical assessmentBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2005P. M. Markus Background: The aim of this study was to determine the accuracy of prediction of the surgeon's ,gut-feeling' in estimating postoperative outcome. Methods: A prospective series of 1077 consecutive patients undergoing major hepatobiliary or gastrointestinal surgery were studied. Patients having elective (n = 827) and emergency (n = 250) procedures were included. The surgeon predicted the development of postoperative complications immediately after completion of surgery on a scale from 0 to 100 per cent. These predictions were compared with the actual outcome and with predictions made using the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM). The Portsmouth predictor equation (P-POSSUM) was applied for the estimation of mortality. Results: The observed morbidity and mortality rates were 29·5 and 3·4 per cent respectively. POSSUM predicted a morbidity rate of 46·4 per cent and P-POSSUM a mortality rate of 6·9 per cent. The surgeon's gut-feeling was more accurate in the prediction of morbidity at 32·1 per cent. On the basis of gut-feeling, surgeons overpredicted morbidity in elective surgery, but underestimated the risk of complications in the emergency setting. The (P)-POSSUM scoring system overpredicted morbidity and mortality for elective and emergency operations. Conclusion: The surgeon's gut-feeling is a good predictor of postoperative outcome, especially after elective surgery. (P)-POSSUM overpredicted morbidity and mortality in this series of major gastrointestinal and hepatobiliary operations. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Medial canthal tendon repair for moderate to severe tendon laxityCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 2 2004Colin I Clement MB BS PhD Abstract Background:,Medial canthal tendon laxity is a common cause of epiphora and ocular irritation. It is difficult to treat due to the proximity of the lower canaliculus and punctum to the tendon. Methods:,The results of a prospective series of patients with involutional medial canthal tendon laxity between 1997 and 2002 were reviewed. Symptoms and measured laxity were recorded before and after medial canthal tendon repair. The medial canthal tendon was routinely repaired through a cut along the lid margin extending from the punctum medially. This avoids a vertical cut onto the anterior lamella of the eyelid, which is useful if a skin graft is required. Results:,Twenty lower eyelid medial canthal tendon repairs were performed on 17 patients. Preoperatively, the lower punctum in all patients was able to be distracted to the medial limbus or further and in 50% of cases, the lower lid punctum was able to be distracted to the pupil midline or further. Postoperatively all patients had reduction of their medial canthal tendon laxity. Postoperatively in 85% of cases the lower punctum was not able to be distracted beyond the medial limbus; however, 15% of cases still had significant residual laxity. Eighty-five per cent of patients reported improvement in symptoms. Conclusions:,This is an effective procedure in the majority of patients with moderate to severe medial canthal tendon laxity; however, residual lower lid laxity persisted in some patients. [source] To what degree is amelioration of angina following coronary revascularization associated with improvement in myocardial perfusion?CLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, Issue 5 2006Allan Johansen Summary Objective:, To examine the association between changes in chest pain and changes in perfusion following revascularization as assessed by clinical evaluation and myocardial perfusion imaging (MPI) in patients with stable angina. Design:, In a prospective series of 380 patients (58·8 ± 8·8 years) referred to angiography because of known or suspected stable angina, changes in chest discomfort and changes in perfusion after 2 years were assessed in 144 patients, who underwent revascularization, and 236, who did not. The decision to treat invasively was made without knowledge of the result of MPI. Results:, In revascularized patients, the presence of typical/atypical angina was reduced from 93% to 36% and the improvement was associated with improvement in perfusion. A small improvement in perfusion induced a high frequency of change from angina to no pain, whereas a further reduction caused little extra change. In non-revascularized patients the change in chest discomfort was not related to changes in perfusion, which were rarely present. Conclusion:, Alleviation of chest discomfort 2 years after revascularization is associated with improvements in perfusion. This association appeared to be an all-or-nothing phenomenon. Non-revascularized patients also exhibited improvements in chest discomfort despite insignificant changes in perfusion. [source] Self expanding wall stents in malignant colorectal cancer: is complete obstruction a contraindication to stent placement?COLORECTAL DISEASE, Issue 8 2009G. J. A. Stenhouse Abstract Objective, Technical failures have previously been associated with complete clinical obstruction and complete block to the retrograde flow of gastrograffin is considered by some to be a contraindication to the procedure. We report on the technical and clinical success rates of self-expanding metallic stents (SEMS) in both complete and incomplete obstruction in a prospective series of malignant colorectal obstructions. Method, A prospective study of all patients undergoing attempted palliative and bridge to surgery SEMS placement for malignant colorectal obstruction over a 7-year period (April 1999,October 2006) was undertaken. Results, Seventy-two patients (49 males) with a mean age of 71 years (range 49,98) were included. Technical success was achieved in 27 of 32 patients (84%) with complete obstruction and 33 of 36 patients (92%) with incomplete obstruction, P < 0.46, Fishers exact test. Clinical success was achieved in 17 of 26 patients (65%) with complete obstruction and 24 of 33 patients (73%) with incomplete obstruction, P < 0.58, Fishers exact test. Although placed correctly in 89% cases, relief of symptoms occurred in only 71%, P = 0.002, matched pairs test. There were two colonic perforations in the series with one procedure related death. Conclusion, Placement of SEMS for obstructing colorectal cancer is technically successful in a high proportion of cases. Complete radiological obstruction is not a contraindication to stent placement. The relief of obstructive symptoms following successful placement of a wall stent is less predictable. [source] | ||||||||||||||||||||||